Predictors of mortality from pump failure and sudden cardiac death in patients with systolic heart failure and left ventricular dyssynchrony: results of the CARE-HF trial.

BACKGROUND: Determining a specific death cause may facilitate individualized therapy in patients with heart failure (HF). Cardiac resynchronization therapy (CRT) decreased mortality in the Cardiac Resynchronization in Heart Failure trial by reducing pump failure and sudden cardiac death (SCD). This study analyzes predictors of specific causes of death. METHODS AND RESULTS: Univariate and multivariate analyses used 8 baseline and 3-month post-randomization variables to predict pump failure and SCD (categorized as "definite," "probable," and "possible"). Of 255 deaths, 197 were cardiovascular. There were 71 SCDs with a risk reduction by CRT of 0.47 (95% confidence interval 0.29-0.76; P = .002) with similar reductions in SCD classified as definite, probable, and possible. Univariate SCD predictors were 3-month HF status (mitral regurgitation [MR] severity, plasma brain natriuretic peptide [BNP], end-diastolic volume, and systolic blood pressure), whereas randomization to CRT decreased risk. Multivariate SCD predictors were randomization to CRT 0.56 (0.53-0.96, P = .035) and 3-month MR severity 1.82 (1.77-2.60, P = .0012). Univariate pump failure death predictors related to baseline HF state (quality of life score, interventricular mechanical delay, end-diastolic volume, plasma BNP, MR severity, and systolic pressure), whereas randomization to CRT and nonischemic cardiomyopathy decreased risk; multivariate predictors of pump failure death were baseline plasma BNP and systolic pressure and randomization to CRT. CONCLUSION: CRT decreased SCD in patients with systolic HF and ventricular dyssynchrony. SCD risk was increased with increased severity of MR (including the 3-month value for MR as a time-dependent covariate) and reduced by randomization to CRT. HF death was increased related to the level of systolic blood pressure, log BNP, and randomization to CRT. These results emphasize the importance and interdependence of HF severity to mortality from pump failure and SCD.

Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries.

BACKGROUND: Frailty is an indicator of health status in old age. Its frequency has been described mainly for North America; comparable data from other countries are lacking. Here we report on the prevalence of frailty in 10 European countries included in a population-based survey. METHODS: Cross-sectional analysis of 18,227 randomly selected community-dwelling individuals 50 years of age and older, enrolled in the Survey of Health, Aging and Retirement in Europe (SHARE) in 2004. Complete data for assessing a frailty phenotype (exhaustion, shrinking, weakness, slowness, and low physical activity) were available for 16,584 participants. Prevalences of frailty and prefrailty were estimated for individuals 50-64 years and 65 years of age and older from each country. The latter group was analyzed further after excluding disabled individuals. We estimated country effects in this subset using multivariate logistic regression models, controlling first for age, gender, and then demographics and education. RESULTS: The proportion of frailty (three to five criteria) or prefrailty (one to two criteria) was higher in southern than in northern Europe. International differences in the prevalences of frailty and prefrailty for 65 years and older group persisted after excluding the disabled. Demographic characteristics did not account for international differences; however, education was associated with frailty. Controlling for education, age and gender diminished the effects of residing in Italy and Spain. CONCLUSIONS: A higher prevalence of frailty in southern countries is consistent with previous findings of a north-south gradient for other health indicators in SHARE. Our data suggest that socioeconomic factors like education contribute to these differences in frailty and prefrailty.

Self-perception of aging and vulnerability to adverse outcomes at the age of 65-70 years.

OBJECTIVES. This study examines the relationship between self-perception of aging and vulnerability to adverse outcomes in adults aged 65-70 years using data from a cohort of 1,422 participants in Lausanne, Switzerland. METHODS: A positive or negative score of perception of aging was established using the Attitudes Toward Own Aging subscale including 5 items of the Philadelphia Geriatric Center Morale Scale. Falls, hospitalizations, and difficulties in basic and instrumental activities of daily living (ADL) collected in the first 3 years of follow-up were considered adverse outcomes. The relationship between perception and outcomes were evaluated using multiple logistic regression models adjusting for chronic medical conditions, depressive feelings, living arrangement, and socioeconomic characteristics. RESULTS: The strongest associations of self-perception of aging with outcomes were observed for basic and instrumental ADL. Associations with falls and hospitalizations were not constant but could be explained by health characteristics. CONCLUSIONS: A negative self-perception of aging is an indicator of risk for future disability in ADL. Factors such as a low-economic status, living alone, multiple chronic medical conditions, and depressive feelings contribute to a negative self-perception of aging but do not explain the relationship with incident activities of daily living disability.

Nopeasti liukenevien lääkeaineiden liukenemisnopeuden mittaaminen optisesti

Työssä perehdytään nopeasti liukenevien lääkeaineiden liukenemisnopeuden mittaamiseen optisesti. Tavoitteena olikehittää mittausjärjestely, jolla liukenemisen optinen mittaaminen olisi mahdollista. Työn kirjallisessa osiossa perehdytään liukenemisen teoriaan sekä mittauksien kannalta tärkeään valon absorption ja sironnan teoriaan. Työn kokeellisessa osassa tarkastellaan liukenemisnopeuden mittaamista,sitä varten kehitetyllä mittausjärjestelyllä sekä pohditaan menetelmänsoveltuvuutta nopeasti liukenevien lääkeaineiden liukenemisnopeuden mittaamiseen. Liukenemisnopeuden optinen mittaaminen osoittautui vaikeaksi joissakin tapauksissa pienten hiukkasten keveyden johdosta. Kevyet hiukkaset kostuivat liian hitaasti, mikä aiheutti ongelmia mittauksiin. Nopeasti kostuvilla hiukkasilla liukenemisnopeuden määrittäminen mittaus-signaalin perusteella oli huomattavasti helpompaa. Näillä aineilla mittaukset onnistuivat hyvin.

Specificities of defense mechanisms in bipolar affective disorder: relations with symptoms and therapeutic alliance.

Defense mechanisms as a central notion of psychoanalysis have inspired various levels of interest in research in psychotherapy and psychopathology. Defense specificities have only recently been investigated systematically with regard to several clinical diagnoses, such as affective and personality disorders. For the present study, 30 inpatients diagnosed with Bipolar Affective Disorder I (BD) were interviewed. An observer-rater method, the Defense Mechanisms Rating Scales (DMRS), applied to session-transcripts, of assessment of defenses was used. A matched, nonclinical control group was introduced. Defense specificities in BD encompass a set of 5 immature defenses, of which omnipotence is linked with symptom level. The level of the therapeutic alliance is predicted by mature defenses. These results are discussed with regard to the psychological vulnerability of BD, and treatment implications for psychodynamic psychotherapy with such challenging patients are evoked.

Efeito da aplicação de cianamida hidrogenada e óleo mineral na quebra de dormência e producão do pessegueiro-'Flamecrest'

Com o objetivo de aumentar a produção e qualidade de frutos do pessegueiro- 'Flamecrest', de alta exigência em frio, realizou-se um experimento no Município de Farroupilha-RS, no ano de 2000, com o uso de cianamida hidrogenada e óleo mineral. Estudou-se o efeito de duas diferentes épocas de aplicação dos tratamentos (15-7 e 2-8) sobre a brotação, floração, frutificação, produção e antecipação de colheita. Foram testados os efeitos dos seguintes tratamentos: cianamida hidrogenada (C.H.) 1,22; 2,45; 3,675 e 4,90 g de i.a.L-1 com óleo mineral (O.M.) 10 g de i.a.L-1; O.M. 10 g de i.a.L-1 isolado e testemunha (sem pulverização). Os tratamentos não anteciparam a brotação das gemas floríferas, porém C.H. 2,45 e 4,90 g de i.a.L-1 com O.M. a 10 g de i.a.L-1 proporcionaram plantas com maior brotação das gemas vegetativas. Não houve efeito marcante dos tratamentos sobre a floração e a porcentagem de frutos vingados nas duas épocas. O número de frutos raleados por planta foi superior para os tratamentos com C.H. 2,45 e 4,90 g de i.a.L-1 com O.M. 10 g de i.a.L-1 quando aplicados na segunda época. Já, para o número e massa total dos frutos colhidos, destacaram-se, na primeira época (15-7), os tratamentos com C.H. 1,22 e 3,675 g de i.a.L-1 + O.M. 10 g de i.a.L-1 e, na segunda época (2-8), os tratamentos com C.H. 2,45 e 4,90 g de i.a.L-1 + O.M. 10 g de i.a.L-1. Os tratamentos da segunda época resultaram em produções médias superiores à primeira. A massa média dos frutos não foi alterada de forma clara pelos tratamentos, assim como o teor de sólidos solúveis totais e a resistência de polpa.

Produtividade de genótipos de maracujazeiro azedo sob doses de potássio, no Distrito Federal

Objetivando avaliar o efeito de três diferentes níveis de adubação potássica sobre a produção do maracujazeiro azedo (Passiflora edulis Sims e P. edulis Sims f. flavicarpa Deg.), foi realizado um experimento na Fazenda Água Limpa da Universidade de Brasília de dezembro/1999 a maio/2001, utilizando-se o delineamento em blocos casualizados, em esquema fatorial 9x3, sendo nove genótipos e três níveis de adubação potássica, totalizando 27 tratamentos, quatro repetições e nove plantas úteis/parcela. Os genótipos avaliados foram: Híbrido EC-2-0; Marília Seleção Cerrado; F1 (Roxo Fiji x Marília); Porto Rico; Vermelhão (RC1); F1 (Marília x Roxo australiano); Redondão; IAC-273 e Itaquiraí. Os três níveis de adubação potássica aplicados foram de 0, 640 e 1280 kg de K2O ha-1, utilizando-se como fonte o cloreto de potássio. Ao final de cinco meses de colheita os genótipos híbrido EC-2-0 e Marília Seleção Cerrado foram os que apresentaram as maiores produções (21.675 e 21.577 kg ha-1) e maiores números de frutos por planta (155,28 e 149,24), respectivamente. O peso médio de fruto variou de 88g (Itaquiraí) até 103,42g (F1 - Marília x Roxo Australiano). As doses de adubação potássica influenciaram as seguintes variáveis estudadas: produção de frutos de primeira ha-1; produção frutos totais ha-1; peso médio de frutos de primeira e peso médio de frutos 1A. A interação genótipos x adubação potássica apresentou diferença estatística para o número de frutos de primeira/planta para uma dosagem de 640 kg K2O ha-1.

Diversidade genética de pitayas nativas do cerrado com base em marcadores RAPD

As pitayas do Cerrado vegetam naturalmente sobre maciços rochosos de arenito ou quartzito, troncos de árvores e em solos arenosos de campos rupestres de Minas Gerais, Bahia, Goiás, Distrito Federal, Tocantins, Rio de Janeiro e Bahia, havendo fortes evidências de que a região central do Brasil seja o maior centro de dispersão das pitayas, tendo em vista a grande diversidade fenotípica observada em acessos coletados. Objetivou-se realizar o estudo da diversidade genética de 13 acessos de pitayas mantidos na coleção de germoplasma da Embrapa Cerrados por meio de marcadores moleculares RAPD (Random Amplified Polymorphic DNA). O DNA genômico de cada acesso foi extraído, e quatorze iniciadores decâmeros foram utilizados para a obtenção de marcadores moleculares RAPD, que foram convertidos em matriz de dados binários, a partir da qual foram estimadas as distâncias genéticas entre os acessos com base no complemento do coeficiente de similaridade de Nei e Li (1979) e realizadas análises de agrupamento e de dispersão gráfica. Foram obtidos 162 marcadores RAPD, perfazendo uma média de 11,57 marcadores por primer. Do total de marcadores, 154 (95,06%) foram polimórficos. As distâncias genéticas variaram entre 0,088 e 0,848, sendo que os maiores valores observados se referem a distância entre o acesso de Unaí-MG e o acesso Seleção Embrapa Cerrados. O acesso que mais se diferenciou dos demais foi "Unaí-MG", que apresentou uma distância genética média de 0,675 em relação aos demais acessos. A alta distância genética verificada é devido ao fato de os referidos acessos não pertencerem à mesma espécie. Os agrupamentos dos acessos de pitaya pouco se relacionaram com a origem geográfica dos mesmos. A grande diversidade genética das pitayas encontradas no Cerrado permite incluir esse Bioma no centro de diversidade e abre boas perspectivas para maiores estudos acerca do potencial dessa frutífera.

Estado actual de fruticultura colombiana y perspectivas para su desarrollo

La horticultura en Colombia comprende las áreas de floricultura, fruticultura, olerícultura, producción de plantas aromáticas y medicinales y la horticultura urbana. La promoción y desarrollo del sector frutícola representa para Colombia una importante fuente de crecimiento de la agricultura, de generación de empleo rural y de desarrollo con equidad para las distintas regiones puesto que las frutas pueden asentarse en los diversos pisos térmicos de que dispone el país, a la vez que conforma una producción administrada con criterios de eficiencia y sostenibilidad en escalas que van desde micro, pequeños y medianos productores hasta grandes productores y empresas. Durante las últimas cuatro décadas el área sembrada en frutas expresa una dinámica de constante crecimiento, consiguiendo así aumentar su participación tanto en el área dedicada a cultivos no transables, como en el total del área de la agricultura sin café. Así, mientras en 1970 la participación del área frutícola en los no transables era del 1,6%, en el 2005 ésta era del 12,6%. Las áreas plantadas en frutas en Colombia pasaron de 191.035 ha en 2003 a 225.325 ha en 2007 lo que representa un crecimiento de 17,9 %, mientras que los volúmenes de producción pasaron de 2.675.736 t a 3.279.264 t en el mismo período en 47 especies frutícolas. El Plan Frutícola Nacional - PFN, constituye una propuesta estratégica conformada por conjunto coherente de objetivos, estrategias y programas que, con base en una visión de futuro, buscan la meta inicial de duplicar el área de la producción frutícola nacional, asegurar las condiciones tecnológicas y de innovación para una producción sostenible y de calidad, agregar valor en la cadena frutícola, y lograr una vinculación plena en los mercados internacionales. Se busca que los participantes conozcan los principales desarrollos de la fruticultura Colombiana, sus retos y oportunidades para la próxima década.

El Patrimonio paleontológico en los museos y colecciones visitables de Cataluña: evaluación de su gestión

La riqueza del patrimonio paleontológico de Cataluña ha hecho que la Paleontología catalana haya tenido un importante recorrido que se remonta a la segunda mitad del siglo XIX . Este desarrollo histórico ha originado que el patrimonio paleontológico"mueble" se encuentre ubicado dentro de instituciones museísticas de alcance y situaciones muy contrastadas. Para evaluar la situación del patrimonio paleontológico mueble presente en los museos y colecciones visitables de Cataluña, se ha realizado este trabajo de investigación, seleccionando una muestra de las 57 instituciones que tienen colecciones de Paleontología en Cataluña. Los tres objetivos que se pretendían alcanzar eran saber: [1] cuál era la situación y cómo se gestionaba el patrimonio paleontológico, que se encontraba en los museos y colecciones visitables de Cataluña, [2] si el patrimonio paleontológicos se encontraba suficientemente valorado por sus gestores en los museos y colecciones visitables, y por la Administración responsable, [3] cuál podía ser la gestión del patrimonio paleontológico mueble de Cataluña en tiempos de crisis, basándose en experiencias descritas en otros países. Con respecto al primer objetivo se puede decir que las colecciones de Paleontología presentes en los museos y las colecciones visitables de Cataluña son importantes tanto por el número de ejemplares como por su calidad. Indicadores de esta importancia los encontraríamos con los más de 675.000 unidades de registro , y en los más de 1.000 tipos descritos. Pero existen también colecciones de Paleontología de propiedad privada, de las que no se dispone de datos fiables. Las colecciones de Paleontología continúan creciendo tanto por las donaciones y cesiones que se producen por parte de particulares, como los depósitos provisionales provenientes de las actividades de investigación (excavaciones, prospecciones, muestreos, etc....) que realizan los museos y otras instituciones. La comparación de los datos obtenidos en este trabajo, con uno previo de Loran (2006) sobre colecciones de Historia Natural en Cataluña, permiten deducir que la situación prácticamente no ha cambiado. Las carencias y deficiencias que se registran en la gestión y conservación de estas colecciones, son esencialmente las mismas que las descritas para las colecciones de Historia Natural, y tienen su origen en la falta de recursos humanos y materiales. En cuanto al segundo objetivo, la opinión de la gran mayoría de los entrevistados ha confirmado que el patrimonio paleontológico no estaba suficientemente valorado por la Administración competente. Las causas se han atribuido a que el Departament de Cultura de la Generalitat de Cataluña no ha invertido ni los suficientes recursos humanos ni económicos para poner en valor este patrimonio, ni tampoco ha mostrado el suficiente interés en su gestión, conservación y difusión. Finalmente el tercer objetivo que era saber ¿cómo podría afectar la crisis al patrimonio paleontológico conservado en los museos y las colecciones visitables?, partiendo de lo que se ha descrito en otros países. Las respuestas obtenidas permiten afirmar que se podrían producir situaciones de vulnerabilidad en la conservación de los fondos de Paleontología. Tres instituciones podrían tener problemas de conservación, y en otros tres museos peligra su supervivencia. La crisis se ha añadido a situaciones de manifiesta precariedad que se vienen arrastrando desde hace muchos años y que tienen su origen en la falta de inversiones económicas, y de recursos humanos y materiales.

Establishment of a Representative Practice-based Research Network (PBRN) for the Monitoring of Primary Care in Switzerland.

Data are urgently needed to better understand processes of care in Swiss primary care (PC). A total of 2027 PC physicians, stratified by canton, were invited to participate in the Swiss Primary care Active Monitoring network, of whom 200 accepted to join. There were no significant differences between participants and a random sample drawn from the same physician databases based on sex, year of obtaining medical school diploma, or location. The Swiss Primary care Active Monitoring network represents the first large-scale, nationally representative practice-based research network in Switzerland and will provide a unique opportunity to better understand the functioning of Swiss PC.

Clinically meaningful parameters of progression and long-term outcome of Parkinson disease: An international consensus statement.

Parkinson disease (PD) is associated with a clinical course of variable duration, severity, and a combination of motor and non-motor features. Recent PD research has focused primarily on etiology rather than clinical progression and long-term outcomes. For the PD patient, caregivers, and clinicians, information on expected clinical progression and long-term outcomes is of great importance. Today, it remains largely unknown what factors influence long-term clinical progression and outcomes in PD; recent data indicate that the factors that increase the risk to develop PD differ, at least partly, from those that accelerate clinical progression and lead to worse outcomes. Prospective studies will be required to identify factors that influence progression and outcome. We suggest that data for such studies is collected during routine office visits in order to guarantee high external validity of such research. We report here the results of a consensus meeting of international movement disorder experts from the Genetic Epidemiology of Parkinson's Disease (GEO-PD) consortium, who convened to define which long-term outcomes are of interest to patients, caregivers and clinicians, and what is presently known about environmental or genetic factors influencing clinical progression or long-term outcomes in PD. We propose a panel of rating scales that collects a significant amount of phenotypic information, can be performed in the routine office visit and allows international standardization. Research into the progression and long-term outcomes of PD aims at providing individual prognostic information early, adapting treatment choices, and taking specific measures to provide care optimized to the individual patient's needs.

Identification and visualization of multidimensional antigen-specific T-cell populations in polychromatic cytometry data.

An important aspect of immune monitoring for vaccine development, clinical trials, and research is the detection, measurement, and comparison of antigen-specific T-cells from subject samples under different conditions. Antigen-specific T-cells compose a very small fraction of total T-cells. Developments in cytometry technology over the past five years have enabled the measurement of single-cells in a multivariate and high-throughput manner. This growth in both dimensionality and quantity of data continues to pose a challenge for effective identification and visualization of rare cell subsets, such as antigen-specific T-cells. Dimension reduction and feature extraction play pivotal role in both identifying and visualizing cell populations of interest in large, multi-dimensional cytometry datasets. However, the automated identification and visualization of rare, high-dimensional cell subsets remains challenging. Here we demonstrate how a systematic and integrated approach combining targeted feature extraction with dimension reduction can be used to identify and visualize biological differences in rare, antigen-specific cell populations. By using OpenCyto to perform semi-automated gating and features extraction of flow cytometry data, followed by dimensionality reduction with t-SNE we are able to identify polyfunctional subpopulations of antigen-specific T-cells and visualize treatment-specific differences between them.